{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:05:16Z","timestamp":1787238316312,"version":"build-2736575974"},"reference-count":50,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T00:00:00Z","timestamp":1631059200000},"content-version":"unspecified","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,8,9]]},"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec>\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Borderline personality disorder (BPD) is a severe mental disorder that is often inadequately treated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine if adding a self-management intervention to care as usual (CAU) is effective and safe.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Randomised, controlled, rater-blind trial. Duration of treatment and assessments: 12 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Secondary care, recruited mainly via the internet.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Patients with BPD and BPD Severity Index (BPDSI) of at least 15.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>CAU by treating psychiatrist and\/or psychotherapist alone or adjunctive use of an internet-based self-management intervention that is based on schema therapy (priovi).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measure<\/jats:title>\n                    <jats:p>Outcomes were assessed by trained raters. The primary outcome was change in BPDSI. The safety outcome was the number of serious adverse events (SAEs). The primary outcome time point was 12 months after randomisation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 383 participants assessed for eligibility, 204 were included (91.7% female, mean age: 32.4 years; 74% were in psychotherapy and 26% were in psychiatric treatment). The slope of BPDSI change did not differ significantly between groups from baseline to 12 months (F\n                      <jats:sub>3,248<\/jats:sub>\n                      = 1.857, p=0.14). At 12 months, the within-group effect sizes were d=1.38 (95% CI 1.07 to 1.68) for the intervention group and d=1.02 (95% CI 0.73 to 1.31) for the control group. The between-group effect size was d=0.27 (95% CI 0.00\u2009to 0.55) in the intention-to-treat sample and d=0.39 (95% CI 0.09\u2009to 0.68) for those who used the intervention for at least 3\u2009hours (per-protocol sample). We found no significant differences in SAEs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We have not found a significant effect in favour of the intervention. This might be due to the unexpectedly large effect in the group receiving CAU by a psychiatrist and\/or psychotherapist alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial results\" xlink:href=\"NCT03418142\">NCT03418142<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-047771","type":"journal-article","created":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T23:00:34Z","timestamp":1631142034000},"page":"e047771","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":25,"title":["Effectiveness and safety of the adjunctive use of an internet-based self-management intervention for borderline personality disorder in addition to care as usual: results from a randomised controlled trial"],"prefix":"10.1136","volume":"11","clinical-trial-number":[{"clinical-trial-number":"nct03418142","registry":"10.18810\/clinical-trials-gov","type":"results"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9882-2261","authenticated-orcid":false,"given":"Jan Philipp","family":"Klein","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Psychosomatics and Psychotherapy, University of L\u00fcbeck, Lubeck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Hauer-von Mauschwitz","sequence":"additional","affiliation":[{"name":"Gaia AG, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2432-7791","authenticated-orcid":false,"given":"Thomas","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Fassbinder","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Psychosomatics and Psychotherapy, University of L\u00fcbeck, Lubeck, Germany"},{"name":"Department of Psychiatry and Psychotherapy, Christian-Albrechts-Universit\u00e4t zu Kiel, Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Mayer","sequence":"additional","affiliation":[{"name":"Gaia AG, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5792-3987","authenticated-orcid":false,"given":"Stefan","family":"Borgwardt","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Psychosomatics and Psychotherapy, University of L\u00fcbeck, Lubeck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Wellh\u00f6fer","sequence":"additional","affiliation":[{"name":"Gaia AG, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"Schweiger","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Psychosomatics and Psychotherapy, University of L\u00fcbeck, Lubeck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gitta","family":"Jacob","sequence":"additional","affiliation":[{"name":"Gaia AG, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,9,8]]},"reference":[{"key":"2025101811163686000_11.9.e047771.1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2018.202"},{"key":"2025101811163686000_11.9.e047771.2","doi-asserted-by":"publisher","DOI":"10.1111\/acps.13094"},{"key":"2025101811163686000_11.9.e047771.3","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1159\/000475885","article-title":"\"Abandonment psychotherapy\" for suicidal patients with borderline personality disorder: long-term outcome","volume":"86","author":"Burnand","year":"2017","journal-title":"Psychother Psychosom"},{"key":"2025101811163686000_11.9.e047771.4","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1159\/000460257","article-title":"Change of unresolved attachment in borderline personality disorder: RCT study of Transference-Focused psychotherapy","volume":"86","author":"Buchheim","year":"2017","journal-title":"Psychother Psychosom"},{"key":"2025101811163686000_11.9.e047771.5","doi-asserted-by":"crossref","unstructured":"Storeb\u00f8 OJ , Stoffers-Winterling JM , V\u00f6llm BA , et al . 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